Private Bag 9023 | Whangarei 0148 | New Zealand
T: 09 430 4200 | 0800 WDC INFO | 0800 932 463 | F: 09 438 7632
W: www.wdc.govt.nz | E: [email protected]
Application to transfer plot reservation to another plot number
1
Details of person applying to transfer plot number
Date
Surname
Forenames
Postal address
Phone
2
Please give below current plot number and name(s) in which it is reserved
Current plot no
Surname(s)
3
Forenames (in full)
Please give below new plot number
Transferred to plot no
4
Declaration
I
hereby confirm that I have the authority
Name of the person completing the form
to dispose of and agree to the transfer of plot no
to
Old plot number
Signed (Signature of the person completing the form)
Fee
New plot number
Date (Today’s date)
GST inclusive
$34.00
Office use
Receipt no
 Email sent to cemetery manager
Receipt date
 Form sent to cemetery office
Customer service representative name
 Confirmed entered in register
10/11097
CSR initials
 Confirmed entered onto database
July 2015
Cemetery admin
initials
1
Private Bag 9023 | Whangarei 0148 | New Zealand
T: 09 430 4200 | 0800 WDC INFO | 0800 932 463 | F: 09 438 7632
W: www.wdc.govt.nz | E: [email protected]
Guidance notes for the completion of form
Application to transfer plot reservation to another plot number
Please complete all sections
Enter today’s date
Date
1
Details of person applying to transfer plot number
Surname
Enter the surname of person applying to transfer the plot to another number
Forenames
Enter the forenames of person applying to transfer the plot to another number
Postal address
Enter the full postal address of person applying to transfer the plot to another number
Phone/Mobile
Enter the contact telephone number of person applying to transfer the plot to another
number
2
Please give below current plot number and name(s) in which it is reserved
Current Plot number Enter the plot number as stated on the certificate of title
Surname(s)
Enter the full surname of the person(s) for whom the plot was previously reserved
Forenames (in full) Enter the full forenames of the person(s) for whom the plot was previously reserved
3
Please give below new plot number
Transferred to plot number Enter the new plot number as advised by the cemetery manager
4
Declaration Person applying to transfer plot reservation to another name should complete the
Declaration, then sign and date it
Office use
To be completed by the customer services representative
Should you require any assistance in completing this form please contact a customer services
representative, or if you have any related questions, please contact the cemetery manager.
10/11097
July 2015
2